Warning Signs in the Emergency Department

Francis S. enters a hospital emergency department to treat unbearable pain after cancer treatment; Alexa W. goes in for insomnia. But unless the warning signs are detected, no one will know that both patients are suicidal.

For EDC’s David Litts, this scenario is all too common. “A patient might be there to ask for help sleeping, but what they’re not saying is, ‘If I don’t get some sleep soon, I might kill myself,’” says Litts.

The reality is that 1 in 10 patients in an emergency department is harboring thoughts of suicide, and many medical personnel don’t realize it by the time that patient is discharged.This led EDC, with leading emergency department doctors and nurses, to develop “Is Your Patient Suicidal?” a simple, quick checklist that is used in hundreds of hospitals across the country today.

Displayed in poster format, the list includes such signs of suicide as substance abuse, insomnia, recklessness, and social withdrawal. The effectiveness of the poster is now being evaluated by the University of Rochester in New York.

“With this information, personnel are able to ask fairly simple questions, also on the poster, to gauge whether a person is harboring thoughts of suicide,” says Litts. “Now the evaluation will tell us how effective this intervention has been.”

The evaluation is part of a larger independent study led by the university that is testing a variety of interventions in six emergency departments across New York. The Substance Abuse and Mental Health Service Administration (SAMHSA), a division of the U.S. Department of Health and Human Services, funded the creation of the poster as well as part of the evaluation, with supplementary funding coming from the University of Rochester.

The Emergency Nurses Association distributes the posters to hospitals all over the country. And in Washington state, the Department of Health supplies the posters to emergency departments in all hospitals in that state, free of charge.

The information on the poster grew out of a curriculum development project called Assessing and Managing Suicide Risk, which was developed by the Suicide Prevention Resource Center at EDC, and which has been presented in workshops in 40 states and on 45 Air Force bases around the world. The poster was among the materials developed by EDC for that project, which also included brochures and a guide addressing how to detect whether a patient in an emergency department is suicidal and how to direct those patients to medical treatment once they are discharged.

“Historically, because no one recognizes they are suicidal, a large portion of suicidal patients in the emergency department get little to no emergency department care or continuity of care after they leave,” says Litts. “We’re hoping these materials help improve their odds.”